Hello. My name is Brandon Boyd, and I'll be presenting our study, Risk Factors for Surgical Site Infection after Operative Management of Pilon Fractures. This study was conducted in affiliation with the Department of Orthopedic Surgery at the University of Alabama, Birmingham. Introduction. Pilon fractures result from high energy trauma leading to extensive fracture combination and soft tissue damage. Current operative management prioritizes initial soft tissue protection with subsequent definitive fixation. Despite concerted efforts, extensive soft tissue damage remains a serious concern as it is associated with post-operative complications such as wound dehiscence and infection. The purpose of this study is to identify risk factors associated with surgical site infection following operative management of pilon fractures. We, the authors, have no disclosures. A retrospective review of all operatively managed pilon fractures at a single level in trauma center from 2014 to 2019 was performed. Minimum six-month follow-up and skeletal maturity was required for inclusion. Patients with amputation prior to definitive fixation were excluded. Patients were grouped based on the presence of surgical site infection or no infection. Surgical site infection consisted of superficial and or deep infection. Deep infection was defined as a return to the operating room for debriement with positive cultures. Demographics, injury characteristics, operative characteristics, and surgical outcomes were compared between the two groups. The results. A total of 279 patients met inclusion criteria for this study, with 40 patients developing surgical site infection, which is 14.3% of our cohort. Average follow-up was 3.2 years. A total of 95.4% of patients suffered high energy injury. Patients that developed surgical site infection had significantly higher proportion of open fractures. However, there's no significant difference in the Gaspio-Anderson classification or location of the open wound between the two groups. Surgical site infection group required significantly higher rate of skin grafting and muscle flap coverage following operative fixation. Operative time was also significantly longer in the surgical site infection group. Patients with surgical site infection displayed significantly higher rates of nonunion at six-month follow-up when compared to those without surgical site infection. There's also significantly higher rate of wound dehiscence and malunion within the surgical site infection group when compared to those without surgical site infection. There's no significant differences in the mechanism of injury, AO, OTA fracture classification, ipsilateral lower extremity injuries, utilization of bone grafting, surgical approach, or presence of neocolon fixation between the two groups. In conclusion, the present study shows that surgical site infection after pilon fracture has a devastating prognosis, with 55% of patients developing nonunion at six months. Risk factors for surgical site infection in these patients included open fractures, receiving soft tissue coverage, and longer operative time. In conclusion, I hope you enjoyed this presentation and found it educational. Thank you for taking the time to listen to this presentation. I hope you enjoyed it and found it educational.

Risk Factors

Surgical Site Infection

Operative Management

Pilon Fractures

Soft Tissue Damage